By Geralyn Magan
When nursing homes implement culture change fully, the benefits include significant improvements in resident perceptions of quality of life, services, and care.
Nursing homes must implement culture change fully before they can reap many of its benefits, according to early findings from an ongoing study by the LeadingAge Center for Applied Research (CFAR). But when full implementation does occur, the benefits of culture change include significant improvements in resident perceptions of quality of life, services, and care.
“These are the most important measures that should improve with culture change adoption,” said Dr. Linda Hermer, CFAR’s senior research scientist and managing director of research, and the study’s chief investigator.
CFAR researchers also found that residents living in nursing homes implementing culture change can expect to experience reductions in:
- Depressive symptoms,
- Antipsychotic drug use,
- Pressure ulcers,
- Incontinent episodes,
- Catheter use, and
- Urinary tract infections.
The research findings, presented by Hermer at the 2016 LeadingAge Annual Meeting in Indianapolis, come from CFAR’s ongoing evaluation of PEAK 2.0, a Medicaid pay-for-performance incentive program established in 2012 to facilitate the adoption of culture change in Kansas nursing homes.
Hermer described the CFAR research as “one of the largest studies ever done in the United States of nursing home culture change, with the best statistical control that has been achieved so far.”
The Retirement Research Foundation is funding the CFAR research.
PEAK 2.0: OFFERING INCENTIVES FOR CULTURE CHANGE
Established in 2012, the PEAK 2.0 program offers generous financial incentives to 240 Kansas nursing homes that are implementing culture change. PEAK 2.0 incentives range from 50 cents to $4 per Medicaid resident per day, depending on the nursing home’s stage of culture change adoption.
“A home with 100 Medicaid beneficiaries would get $144,000 from the Kansas government each year if it was at a high level of culture change adoption,” said Hermer. “So this is a significant incentive.”
Nursing homes entering the PEAK program participate in a year-long structured program designed to educate managers and direct care workers about how to implement the program’s definition of culture change, which features 12 program areas within 4 main domains:
- Resident Choice in such areas as dining, sleeping, bathing, and daily routines.
- Staff Empowerment in such areas as relationships with residents, care decisions, staff-led work terms, and career development.
- The Home Environment as it relates to both resident bedrooms and to neighborhoods or households.
- Meaningful Life, including how well the nursing home supports the human spirit and facilitates community involvement among residents.
The PEAK 2.0 Program evaluates nursing homes annually to determine their stage of culture change adoption. The program’s stages range from “Stage 0” for nursing homes that are not implementing culture change, to “Stage 4” for nursing homes carrying out sustained culture change implementation in all program areas.
QUANTIFYING THE BENEFITS OF CULTURE CHANGE
After analyzing a variety of resident satisfaction and health measures, CFAR researchers found that the benefits of culture change increased steadily as PEAK participants implemented culture change more fully.
Stage 4 homes showed consistently better outcomes, in the areas of resident health and well-being, than homes at any other stage in the program, said Hermer. The findings, she said, were highly statistically significant. For example:
- Clinical depressive symptoms were reported for 7.1% of Stage 0 nursing home residents, but only 3.8% of Stage 4 nursing home residents.
- Excellent or good quality-of-life ratings from residents rose from 81.5% (Stage 0) to 87.6% (Stage 4).
- Excellent or good quality-of-care ratings from residents rose from 80.7% (Stage 0) to 87.2% (Stage 4).
- Excellent or good quality-of-service ratings from residents increased from 80.4% (Stage 0) to 85.5% (Stage 4).
- Overall satisfaction, rated by residents as excellent or good, rose from 84.6% (Stage 0) to 93.1% (Stage 4).
“The psychosocial benefits of adopting culture change didn’t accrue until there was adoption in all program areas and it was sustained,” says Hermer.
MESSAGE FOR PROVIDERS
Providers implementing culture change can take heart from the new findings, says Hermer. But before these providers get too complacent, they should make sure that they are actually implementing culture change at a high level, she warns.
“Many nursing homes think that they are full adopters of culture change,” said Hermer. “But when they learn more about it, they realize that they are not. Unless you can say that culture change has completely changed the way you care for residents in all 4 of the PEAK 2.0 domains, you are probably not implementing culture change fully enough to reap the benefits we found in this study.”